Cancer Center Helps Patients Quit Smoking
By Darcy De Leon
How do you quit a long-time nicotine addiction at one of the most stressful times of your life after being diagnosed with cancer?
M.D.Anderson offers its patients free help through its new Tobacco Treatment Program. Since opening in January, the staff has scheduled more than 2,300 appointments (from doctor referrals or patient self-referrals), says Michael Mallen, Ph.D., a postdoctoral fellow in M.D.Andersons Department of Behavioral Science.
Program counselors, who hope the program will become a model for other cancer centers, share strategies they have used to help patients quit.
Counselors honor patients decisions
The first goal of any tobacco cessation program is to learn whether a patient wants to quit and is ready to try, says Danielle Devine, Ph.D., abehavioral research psychologistwith the program who counsels an average of 70 patients a month.
A lot of patients are quite motivated to quit because of their cancer diagnosis, Devine says. Some patients are coming to see us because a doctor told them to or a family member encouraged them to do it, so we try to talk about what their goals are.
Doctors might recommend patients quit tobacco (cigarettes, cigars or smokeless tobacco) to give the lining of the lungs time to heal before certain surgeries. Quitting also helps reduce treatment complications and decreases the risk of cancer returning.
If patients are undecided about quitting, counselors talk about the pros and cons of smoking to help them move toward a decision.
Our counselors dont pressure people, Devine says. We respect whatever decisions patients make. One thing we know is that quitting is really hard to do, and it takes a lot of motivation and commitment.
Counselors learn about daily patterns, create plan
For patients who are ready to quit, an individualized smoking cessation plan is created by the entire team of clinicians and then presented to the patient.
Part of the quit plan involves:
- Identifying daily triggering behaviors
- Uncovering motivation for the behaviors
- Adopting alternative coping strategies
- Tobacco cessation medication(s)
Tobacco use may be associated with these triggers:
Waking upSmoking in the morning helps reduce withdrawal symptoms. Alternatives: brushing teeth, drinking orange juice or exercising.
Drinking coffeeCoffee and cigarettes are a relaxing habit. Alternatives: drinking tea or drinking coffee in a non-smoking area.
DrivingStress from traffic compels some people to light up while driving. Alternatives: chewing gum, sucking peppermints and removing car lighters.
Writing, studying or readingTobacco use helps some people concentrate. Alternatives: taking breaks or eating hard candy.
Being around other smokersTobacco use plays a large part in socializing. Alternatives: avoiding other smokers or asking others not to smoke.
Medication treats biological aspect of addiction
In addition to counseling, many smoking cessation programs nationwide include medication to treat the biological nature of the addiction. Quitting smoking is not just about willpower or your motivation to quit, Mallen says. Its a biological addiction.
Medications, which now are provided to patients at no cost, include:
Nicotine replacement therapyNicotine substitutes in the form of gum, patches, lozenges and inhalers reduce nicotine levels gradually.
AntidepressantsThe anti-depressant bupropion (Zyban) reduces withdrawal symptoms.
Nicotine blocking drugsVarenicline (Chantix), a new drug, partially activates nicotine receptors in the brain to reduce severity of cravings and withdrawal symptoms. Also, if patients smoke while taking varenicline, the drug has the potential to reduce the sense of satisfaction from smoking.
Cancer treatment is a factor in quitting
Because cancer treatment is physically taxing, counselors help establish goals that are flexible and individual.
We try to help patients set a quit date, but some patients work up to it gradually, Mallen says. I have a patient who reduced smoking by two cigarettes a week for a month and then quit. That patient now has been abstinent for a few months.
Other patients might be ready to quit immediately because smoking is too painful or physically impossible during cancer treatment. Nausea and fatigue from chemotherapy, for example, have prevented some of Devines patients from feeling like smoking, she says. Radiation therapy to the head and neck also has made some patients throat and mouth tissues too sensitive for tobacco use.
Because the challenge for patients who quit during treatment is to remain abstinent when treatment side effects have passed, counselors focus their efforts on helping patients avoid relapse.
Giving up a nicotine addiction is a difficult process, but many patients have succeeded and remained abstinent, Mallen says.
Its rewarding. We follow up with patients and hear that many have been abstinent for several months or reduced the amount they smoke.
The Tobacco Treatment Program is available to all eligible and interested M.D.Anderson patients. For more information or to register, visit the Tobacco Treatment Program website.
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